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QJM Advance Access originally published online on May 6, 2005
QJM 2005 98(6):403-413; doi:10.1093/qjmed/hci070
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Review

Osteoporosis therapy: an example of putting evidence-based medicine into clinical practice

D.J. Hosking1, P. Geusens2 and R. Rizzoli3

From the 1Nottingham City Hospital, Nottingham, United Kingdom, 2Biomedical Research Institute—LUC, Diepenbeek, Belgium, and 3Division of Bone Diseases, University Hospital, Geneva, Switzerland

Address correspondence to Dr D.J. Hosking, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB. e-mail: dhosking{at}ncht.trent.nhs.uk

A major aim of evidence-based medicine is to assist clinical decision-making by providing the most current and reliable medical information. Systematic reviews and meta-analyses are important tools in this process. Systematic reviews identify and compile relevant evidence, while meta-analyses summarize and quantify the results of such reviews. Results from meta-analyses are, at present, the main source of summary evidence for the efficacy of treatments for a specific condition. They are important tools for helping to choose among treatment options, although they cannot be used to directly compare the magnitude of the effect of various therapies. However, the methods used and the consequent clinical value of the results, may be poorly understood by clinicians, who may therefore not take full advantage of the evidence.

Recently, a panel of experts in osteoporosis and evidence-based medicine applied rigorous, validated, scientific standards to produce a systematic review and meta-analysis of randomized controlled trials of anti-resorptive agents used to treat osteoporosis. They found that, although several agents reduced the risk of vertebral fracture, only two, alendronate and risedronate, demonstrated convincing evidence for both non-vertebral and vertebral fracture risk reductions. The clinical implication of these results is that there are important differences in anti-fracture efficacy among currently available agents. In the absence of evidence from head-to-head clinical trials and because of the systematic nature and methodological rigor of the analyses, these data provide important information for clinical decision-making.


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